Health insurance in Nepal

Every citizen shall have the right to get basic health care and have equal access to health services. These are the fundamental rights guaranteed in the Constitution of Nepal. Besides, Nepal aims to fulfil its commitment of achieving Goal 3 of the United Nations Sustainable Development Goals, which is ensuring good health and wellbeing of the people by 2030.

To ensure the health care services for all, the government of Nepal has started health insurance programme in few districts. For the universal health coverage government has adopted the vision of overall health improvement of people through social health security. Health insurance programme is to have access for preventive, curative and rehabilitative health services.

According to this programme, a household is considered as a unit and has to pay premium of Rs 2,500 annually to get the services worth up to Rs 50,000. If a family is unable to pay the premium, the government will pay for it. Under the health insurance programme, the insured shall enjoy services like nutrition, psychological counselling, vaccination, family planning, safe motherhood, OPD and emergency services, medications and preventive services including ambulance. However, it doesn’t cover expensive medical equipment, plastic surgery and artificial insemination. The health insurance programme has been initiated with the objective of improving access to and utilisation of quality health services. According to health insurance board, the programme was started from three districts Kailali, Baglung and Ilam in the FY 2016-16. Now it has been extended to 24 districts with overall enrolment of more than three lakh people.

Social health security program has played an exciting role in health care systems. Within a very short period of time it has been able to enrol an encouraging number of members. This will help to reduce the huge expenditure on health care services and increasing access of poor people.

For the effective implementation of this programme, local health delivery should have to be improved drastically.

To achieve the fundamental right of healthcare, government should improve health service delivery as well as health insurance programme. Until and unless there is drastic improvement in health delivery, a thoughtfully designed health insurance policy only can’t improve the overall health status of the people.